Mid‑Interview Season: When to Start Drafting Your Preliminary Rank List

The biggest mistake applicants make is waiting until “after interview season” to think about their rank list. By then, your memory is warped, your notes are scattered, and your gut is fried.

You should be building your preliminary rank list in the middle of interview season. Not at the end. Not the night before the NRMP deadline.

I’ll walk you through exactly when to start, what to do each week, and how to not lose your mind while doing it.

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Big-Picture Timeline: When Rank List Work Really Starts

At this point in the cycle—mid‑interview season—you’re probably:

• Halfway or more through your scheduled interviews
• Checking email like it’s a cardiac monitor
• Telling yourself, “I’ll sort it all out later”

That “later” is how people end up crying over a spreadsheet in late February.

Here’s the real structure you should be following.

Residency Ranking Work Across the Season

Period	Event
Early Season - Before 1st Interview	Create template, define priorities
Early Season - After 1st Interview	Start live ranking + notes
Mid-Season - After 3-5 Interviews	Weekly rank review
Mid-Season - Peak Interview Weeks	Same-day debrief and quick re-rank
Late Season - Last 2-3 Interviews	Careful integration into existing list
Late Season - 2-3 Weeks Before Cert Deadline	Lock preliminary list, stress-test it
Late Season - Final Week	Minor tweaks only, then certify

Let’s zoom in, mid‑season, week by week and day by day.

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Step 0 (1–2 Weeks Before First Interview): Set Up Your System

If you’re already in the middle of interview season, fine—do this tonight.

At this point you should create a rank list infrastructure so you’re not making decisions from a pile of half-remembered impressions.

Create a central tracking sheet (Google Sheets, Notion, Excel—pick one and stick to it):

Columns I strongly recommend:

• Program name
• City / region
• Specialty + track (categorical, prelim, advanced, rural, etc.)
• Interview date
• Overall vibe score (1–10)
• “Would I be happy here?” (Yes/Maybe/No)
• Training quality (subjective score)
• Work-life balance
• Geography & family fit
• Research/opportunities in your interest area
• Call schedule / night float
• Fellowships / post-residency prospects
• Gut rank position (you’ll fill this later)
• Notes: red flags
• Notes: green flags / “moments I liked”

Decide on your “non-negotiables” now, not in February:

Examples I’ve seen work well:

• Must be within X hours of partner/family
• No programs with malignant culture or chronic duty hour violations
• Need strong fellowship placement in [field]
• Cannot afford a super high cost-of-living city on PGY-1 salary

Put these at the top of your sheet as text or on a separate tab. You’ll forget what you said was “non-negotiable” after your fifth free hotel breakfast.

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Step 1: After Your First 1–2 Interviews – Start the Preliminary List

You don’t wait. You start immediately.

At this point you should:

Same Day (or Within 24 Hours) of Each Interview

If you leave it 3–4 days, your memory will distort. I’ve watched people merge five programs into one vague blob in their head.

Within 24 hours:

1. Do a 10-minute brain dump

   • What surprised you (good or bad)?
   • Specific things faculty/residents said
   • Anything that made your stomach drop
   • Any “this could be home” moment

2. Score quickly

   • Give an overall vibe score 1–10
   • Mark any hard “No” or “Probably not” programs immediately. Do not be sentimental here.

3. Place it on a live rank list

   • Literally ask: “Given only the programs I’ve seen so far, where does this one sit?”
   • Don’t worry about perfection. This is scaffolding.

You should have a running ordered list starting with Interview #1. After Interview #2, you must decide: above or below #1? No ties. Force yourself.

That discomfort is productive. It tells you your real priorities.

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Step 2: Weeks 2–4 of Interview Season – Build the Mid-Season Engine

By mid‑season (usually after 3–5 interviews), you’re in the critical zone.

This is when you start drafting a real preliminary rank list—not just “vibes.”

At this point you should:

Weekly Routine (Once a Week, Same Day)

Pick a consistent time—Sunday night, Friday afternoon, whatever. Commit.

Each week:

1. Freeze the list as of that week

   • Copy your ranked programs into a second tab: “Rank Snapshot – Week X”
   • This helps you see how your feelings change over time (and how recency bias hits you).

2. Do a structured review of your top 5–10 For each of the top programs, glance at:

   • Call schedule and hours
   • Resident happiness (from your notes)
   • City / cost-of-living basics
   • Any red flags you wrote down in the moment

   Then ask: “Does this program still deserve a top spot?” Move it if needed.

3. Re-check your non-negotiables Programs slipping into your top tier that violate your own rules? Fix that. This is where people sabotage themselves—falling for prestige and ignoring that their partner lives 1,200 miles away.

4. Write a 1–2 sentence “Why here?” for each top 5 program

   • If you can’t articulate why it’s in your top 5, that’s a problem.
   • This also doubles as content for thank-you / update emails if needed.

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Mid-Season Daily Flow: During Heavy Interview Weeks

When you hit those brutal weeks with 3–5 interviews, your brain gets mushy fast.

Here’s how to keep your rank list sane during that chaos.

Night Before Each Interview

At this point you should:

• Spend 10 minutes reviewing:
  • Where this program would likely sit if it’s as good as you hope (e.g., “Tentative: somewhere around #3–5”)
  • What you need to learn to place it accurately:
    • How do seniors feel about fellowship placement?
    • Actual call structure vs. what’s on the website
    • Resident turnover / recent transfers

Having these questions ready makes your post-interview ranking much sharper.

Immediately After Each Interview (Same Day)

Minimum actions before you crash:

• Score:

  • Overall vibe (1–10)
  • Culture (supportive vs. sharp vs. chaotic)
  • Location fit (1–10 for you, not in general)

• Capture:

  • One best moment
  • One worst/odd/red-flag moment
  • Key quotes from residents or PD

Then:

• Place it on your running list that day. Even if roughly. Above X, below Y.

Do not wait “until the weekend” during heavy weeks. You won’t remember who was who.

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When You Hit 8–10 Interviews: Shift Into Serious Ranking Mode

Once you’ve seen around 8–10 programs, your list stops being theoretical. Patterns appear. You know what you like and what you hate.

At this point you should:

1. Lock in a “provisional top tier”

Look at your ranked list and define:

• Top tier: “I’d be truly happy here”
• Middle tier: “I’d be fine here—solid training, acceptable life”
• Bottom tier: “I’d go if I had to, but I’m not excited”

Color code them if you want. The exact positions will still shift, but these tiers are gold. They guard you against one flashy late interview kicking a very solid early program way down based only on recency.

2. Start comparing pairs instead of the whole list

Decision fatigue is real. Avoid staring at a list of 15 programs and trying to “sort them.”

Go one pair at a time:

• “All else equal, would I rather match at A or B?”
• Use your non-negotiables and your gut together.

Do this especially for:

• Your top 5–7 programs
• Any program that’s surprisingly high despite a big drawback

3. Mid-Season “Reality Check” (15–30 Minutes)

Ask yourself:

• Are you over-weighting name prestige?
• Are you under-weighting geographic or support network realities?
• Are there programs you moved down only because they were early in the season and now feel “less shiny”?

If you realize you rated some early places harsher just because they were first, adjust.

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Late Mid-Season: Integrating Late Interviews Without Losing Your Sanity

The classic trap: “Well, my last interview felt amazing, so it’s #1.” That’s recency bias, not strategy.

At this point—when you’re 2–4 weeks from finishing interviews—you should have a stable preliminary list that can absorb new programs logically.

Here’s how to handle late-season interviews.

Before a Late-Season Interview

You should:

• Look at your current top 5 and ask:
  • “What would it take for this new place to crack the top 3?”
  • “What would make me put it below my current #7?”

Writing these answers down prevents you from impulsively overvaluing a good lunch or a charismatic PD.

After a Late-Season Interview

Within 24 hours:

1. Score it like usual

2. Ask three questions:

   • Is this genuinely better than my current #1–3 for what I want?
   • Does it violate any non-negotiables?
   • If someone told me I’d definitely match here, would I be relieved or disappointed?

3. Then place it into your list using brackets

   • “Better than #4 but worse than #2 → sits at #3.”
   • Don’t rearrange the entire list every time. Just slot it in.

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2–3 Weeks Before Rank List Deadline: From Preliminary to Almost-Final

For NRMP, rank lists are usually due in late February–early March. Work backward.

At this point (about 2–3 weeks before the deadline) you should be close to done with interviews—or totally done.

This is where your mid-season work pays off. You’re not starting from scratch. You’re refining.

Step 1: Freeze a “Preliminary Final List”

Copy your current ranked list into a new tab: “Preliminary Final.” This is your working draft.

Step 2: Stress-Test the Top 5–10

For each of your top 5–10 programs, do a structured gut check:

• Imagine getting the “You matched at X” email for each program:
  • Do you feel excited?
  • Mildly relieved?
  • A little sick?

If you feel sick about a program in your top 5, it doesn’t belong there.

Step 3: Reality Filters

Run through these filters:

• Support network: Who’s within driving / short flight distance?
• Financial: Can you afford to live there on PGY-1 salary without destroying your mental health?
• Long-term goals: Does this place realistically support your fellowship or career trajectory?

If a program fails all three, it belongs lower than you think.

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1 Week Before Rank List Deadline: Only Tweaks, Not Overhauls

If you’ve been doing mid-season ranking right, this final week is quiet.

At this point you should:

• Make only small changes. Swapping #2 and #3 after thinking about it for a week? Fine. Rebuilding your entire list? Bad sign.
• Double-check programs at the very bottom:
  • Would you truly rather go unmatched than match there? That’s the only reason to exclude a program.
• Make sure you understand NRMP rules: you should rank in your true preference order, not trying to “game” where you think you’ll match.

Here’s a quick structure to think about your list shape:

Tier	Example Rank Positions	Emotional Test
Top Tier	#1–5	"I’d be excited to train here"
Solid Middle	#6–12	"I’d be content and well-trained"
Acceptable Lower	#13–18	"Not ideal, but okay if I land here"
Excluded	Not ranked	"I’d rather scramble/Soap than go here"

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Common Mid-Season Pitfalls (And When They Hit)

Let me be very direct about where people screw this up, chronologically.

Early Interviews (1–3): “I have no idea what I’m doing”

• They: Don’t write anything down, assume they’ll “remember the feel.”
• You should: Force-rank them anyway. Even if you don’t trust your rubric yet, constrain yourself to an ordered list.

Mid-Season (4–10): “Everything’s blending together”

• They: Start saying, “They’re all kind of the same,” and stop updating the list.
• You should: Double down on weekly reviews and short written “Why here?” blurbs.

Late Season (Last 3–5 interviews): “This last place was amazing, it’s #1”

• They: Let recency bias wreck a month of careful thinking.
• You should: Use your brackets—slide programs into the existing structure instead of letting them detonate it.

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Quick Visual: How Your Workload Should Shift

Residency Ranking Workload Across Interview Season

Category	Interview Volume	Rank List Work
Before Season	0	20
Early	40	40
Mid	80	70
Late	50	80
Final Week	0	60

Notice: rank list work peaks before the final week, not during it.

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If You’re Already Deep in Mid-Season and Haven’t Started

Fine. No guilt. Here’s your 48-hour triage plan.

Today (30–60 minutes):

• Build your tracking sheet
• List every program you’ve interviewed at so far
• For each, force a rough rank position using your current memory
• Mark any obvious “No way” programs

Next interview you do:

• Same-day debrief, 10 minutes
• Place it on the list that night—no exceptions

Next weekend:

• Do your first real weekly review: define tiers, check non-negotiables, adjust your top 5–10.

From then on, follow the weekly structure above.

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Stop telling yourself you’ll figure out your preferences “later.” You’re in the middle of the data-gathering phase right now. If you’re not integrating that data as you go, you’re basically throwing it away.

Open your spreadsheet today and, for the programs you’ve already seen, force yourself to choose a #1–#3. Don’t overthink it—just mark them. That’s your starting point.